On 23 October 2013, the Supreme Court of India delivered a historic verdict holding three physicians responsible for the death of Anuradha Saha in a reputed Kolkata hospital 15 years ago and awarded a record compensation of Rs. 11 crore. The verdict was hailed as a potential turning point in Indian medico-legal history and left the medical establishment, including the Indian Medical Association (IMA) and other medical groups, rattled. [1]

Corruption, an undeniable reality in the health sector, is arguably the most serious ethical crisis in medicine today. It is like a hydra-headed monster, and it would not be amiss to say that all of us have come across it at some point of time or the other in our careers.

Corruption can take many forms. Corruption in patient care can mean bribes and kickbacks for procuring contracts for construction of healthcare facilities and purchase and supply of medicines, theft of drugs, and bribes for approval of registration and quality of drugs. How many of us have quietly advised patients to buy drugs from outside, instead of consuming the hospital supplied pills because we are not sure of their quality? Often many doctors receive 10-15% kickback on each investigation prescribed by them, leading to an unnecessary battery of expensive investigations. Tales are common of doctors or hospital directors being given money, luxury goods, and other inducements for signing contracts or prescribing particular drugs. [2]

This results in sub-standard healthcare facilities, drugs, and equipments, and often it is the poor who suffer, as they cannot afford quality medical care. Far greater damage is the corrosion of doctor-patient relationship. Patients do not trust their doctors to be competent or honest, which results in high levels of doctor shopping. Lack of trust in doctors, associated with the cost of consulting them, means many patients rely on pharmacists, who are no better.

Then comes corruption in biomedical research. Unethical clinical trials frequently exploit uneducated patients as "guinea pigs in human form." Subjects are recruited by giving financial incentives, and the consent often is "informed but not understood." In a case that garnered a lot of media attention a couple of years ago, a famous cervical cancer vaccination program in Andhra Pradesh and Gujarat was halted after it led to the death of four teenage girls. The vaccine under study [which was being conducted under the collaboration of Indian Council for Medical Research (ICMR), the respective state governments, and an American non-governmental organization (NGO)] had not even cleared phase III clinical trials.

Corruption in biomedical research also includes publication misconduct among medical professionals in India. In a study conducted across nine institutions in India, the authors found "gift authorship" (65%), alteration of data (56%), plagiarism (53%), and "ghost authorship" as the most common types of publication misconduct. [3] Gift authorship refers to inclusion of a person who does not fulfill the requirements for authorship. Conversely, ghost authorship means non-inclusion of individuals as authors who played a significant role in the work and were qualified for authorship. Some authors slice up their research, carving multiple papers from a single study ("salami" publishing).

Corruption in medical education and accountability of doctors and medical institutions is well known in India, so much so that the apex body, the Medical Council of India (MCI), and its big boss, former MCI president Ketan Desai (himself accused of corruption in granting recognition to private medical colleges) are also not spared. [2] Private medical colleges charge hefty "donation fee" toward admission to their undergraduate as well as postgraduate courses. This results in compromised merit and entry of incompetent healthcare professionals into medicine. Other examples of corrupt practices in private medical colleges include fudging records to show adequate patient numbers and monetary incentives to temporary doctors who turn up only on the days of MCI inspection. One of the authors is also aware of an incident, whereby the head of medicine department of a private medical college was fired by the college management on account of failing students for lack of merit.

Medical accountability is an issue of paramount importance and should not be ignored. And we, as doctors, cannot evade our moral responsibility as the medical profession is considered to be a noble profession since time immemorial. Indian doctors have huge expertise, but as a group, our reputation is poor.

So what can be done? Effective laws and policies by the government, continued role of media, and strong action by the regulatory body are needed. It is necessary to make the people aware about the need for better regulation of medical practices and education. Government must enact laws for effective functioning of private hospitals and nursing homes. MCI must be empowered to become an impartial and strict scrutinizing body.

Kunal Saha, husband of Anuradha Saha, has worked tirelessly toward ensuring transparency in the medical field. He has formed an organization known as People for Better Treatment (PBT), which helps wage a battle against medical negligence and extend a helping hand to the victim's families. [1] The Good Governance for Medicines program, launched as part of the World Health Organization Medicines Strategy, 2004-2007, incorporated corruption as a priority issue. As doctors, we can make a difference too by saying "no" to kickbacks and other monetary incentives. [4]

It is time to acknowledge that corruption in health care entails crimes against humanity. There is no room for complacency; history will not forgive us if we fail in our moral duty to safeguard the cause of ethics in medicine when it is necessary.